Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 72126 | TX |
NPI | 1093474553 |
---|---|
Provider Name | Mrs. Shannon Corey |
First Address | Corpus Christi, TX 78414-4503 |
Second Address | Corpus Christi, TX 78414-4503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 13/12/2021 |